Acupuncture- An Essential Health Benefit (Part 2)
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Acupuncture- An Essential Health Benefit (Part 2)

In Acupuncture- An Essential Health Benefit (Part 1),  I wrote that DOMs are not on the PQRS List of Eligible Professionals. Even if voluntarily addressing the Center for Medicaid & Medicare Services (CMS) PQRS codes that are applicable practice, would they be acknowledged! Would the patient outcomes achieved by DOMS be compared to Western physicians, nurse practitioners, and allied health professionals? Is this even desirable?  The Consortium for Oriental Medicine Research & Education, in collaboration with the World Health Organization and Stanford University, is already working on acupuncture diagnostic codes for the ICD-11 revision. But ICD codes are not the same as quality measures- but for western providers they are going to be very closely associated.  Just something to think through when asking for acupuncture to considered an EHB.

Some quality measures are as simple as a few minutes of smoking & alcohol abuse screening, cessation counseling and intervention. Or  pain & functional status assessment (e.g. Oswestry Disability Index). These measures would not interfere with ones Chinese medicine treatment plan at all! In fact, they might demonstrate to CMS how acupuncture is an Essential Health Benefit (EHB) in action. It may even qualify & quantify the effectiveness of ones Chinese medicine intervention as a whole. This is important because  CMS standards eventually influence private third-party-payers.

The Quality Measure Group Specification Manual can be downloaded from this CMS webpage. Below I have summarized the first 10 groups and the underlying measures that DOMs might be interested in reporting:

Diabetes Mellitus (DM) Measures Group
  • High Blood Pressure Control 
  • Foot Exam 

Chronic Kidney Disease (CKD) Measures Group 
  • Preventive Care and Screening: Influenza Immunization 
  • Blood Pressure Management 

Preventive Care Measures Group 
  • Screening / Therapy for Osteoporosis for Women 65 Years and Older     
  • Assessment / Presence / Absence of Urinary Incontinence in Women 65 Years and Older
  • Preventive Care & Screening: Influenza & Pneumococcal Immunization 
  • Preventive Care, Screening & Follow-up: Body Mass Index (BMI)
  • Preventive Care, Screening & Follow-up: Unhealthy Alcohol Use
  • Preventive Care, Screening and Cessation Intervention & Follow-up: Tobacco Use 

Rheumatoid Arthritis (RA) Measures Group 
  • Functional Status Assessment

Back Pain Measures Group 
  • Initial Visit 
  • Physical Exam 
  • Advice for Normal Activities 
  • Advice Against Bed Rest 

Hepatitis C Measures Group 
  • Counseling Regarding Risk of Alcohol Consumption 
  • Counseling Regarding Use of Contraception Prior to Antiviral Therapy 

Heart Failure (HF) Measures Group
  • Preventive Care Screening and Cessation & Intervention: Tobacco Use

Coronary Artery Disease (CAD) Measures Group
  • Preventive Care Screening and Cessation & Intervention: Tobacco Use
  • Symptom Management 

Ischemic Vascular Disease (IVD) Measures Group 
  • Blood Pressure Management 
  • Preventive Care Screening and Cessation & Intervention: Tobacco Use

Asthma Measures Group 
  • Assessment of Asthma Control 
  • Preventive Care Screening and Cessation & Intervention: Tobacco Use

Remaining Groups:
  • Chronic Obstructive Pulmonary Disease (COPD) 
  • Inflammatory Bowel Disease (IBD) Measures     
  • Sleep Apnea Measures     
  • Dementia Measures     
  • Parkinson’s Disease Measures     
  • Hypertension (HTN) Measures 
  • Cataracts Measures 
  • Oncology Measures 

INTEGRATIVE   MEDICINE  TIP: Because many of the PQRS measures require screening & intervention, or biometric measurements, one should use standard & validated screening methods/ tools. Many of these can be downloaded free of charge from the internet. Others may be purchased or require permission from the developers. Some can be found in the DOWNLOAD section of this website, under Patient Instructions. For more on how to report see 2013 Physicians Quality Reporting System.

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